According to CPT guidelines, a new patient is defined as a patient who has not received any professional services from a physician of the exact same specialty and subspecialty in the same group practice within what time frame?

According to CPT guidelines, a new patient is defined as a patient who has not received any professional services from a physician of the exact same specialty and subspecialty in the same group practice within what time frame?

• A. 3 years
• B. 1 year
• C. 5 years
• D. 10 years

Answer: (A)

In CPT, whether a patient is considered new or established hinges on a three-year look-back for professional services from a physician of the exact same specialty and subspecialty in the same group practice. If the patient has not received any such services in the past three years, they are a new patient; if they have, they are established. So, within three years is the threshold that determines newness. For example, a visit to a cardiologist in the same group practice within two years means the patient is established; if the last visit was beyond three years ago or never occurred, the patient would be new. The criterion specifically requires the exact same specialty and subspecialty within the same group practice, and does not count services from different specialties or different practices toward breaking new-patient status.

In CPT, whether a patient is considered new or established hinges on a three-year look-back for professional services from a physician of the exact same specialty and subspecialty in the same group practice. If the patient has not received any such services in the past three years, they are a new patient; if they have, they are established.

So, within three years is the threshold that determines newness. For example, a visit to a cardiologist in the same group practice within two years means the patient is established; if the last visit was beyond three years ago or never occurred, the patient would be new. The criterion specifically requires the exact same specialty and subspecialty within the same group practice, and does not count services from different specialties or different practices toward breaking new-patient status.